PCN Early Cancer Care Coordinator

Job description

Job responsibilities

• Ensure that all patients are signposted to or receive information on their referral including why they are being referred, the importance of attending appointments and where they can access further support.
• Be available for patients with cancer, or their relatives, to ask questions and deal with problems that arise, linking in or signposting to services such as the hospital team, district nursing or Macmillan services, benefits agency as appropriate.
• Review patients and follow up each patient for a period of time after cancer diagnosis, covering topics such as benefits, support groups, offering support to relatives.
• Arrange a cancer care review six months after initial diagnosis with a practice nurse.
• Be a point of contact for survivors of cancer, or bereaved relatives who need support, signpost to support groups available locally or nationally as appropriate.
• Support the practices in your PCN in improving local uptake of National Cancer Screening Programmes, understand the practices data for uptake on screening and understand how the practice can carry out the screening.
• Support the practices in your PCN in conducting peer to peer learning events that look at data and trends in diagnosis across the PCN, including cases where patients presented repeatedly before referral and late diagnoses.
• Support with the education for practice teams and patients and coordinate screening promotion events with the practices across the PCN.
• Support the practices in your PCN to engage with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance and Public Health Commissioning teams.
• Link in with and build relationships with the wider PCN team, Social Prescribers, Pharmacist, Health and Wellbeing Coach and other clinical/non-clinical partners involved in the patients care.
• Holistically bring together all of a person's identified care and support needs and explore options to help them achieve their needs.
• Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care.
• Provide coordination and navigation for people and their carers across health and care services, working closely with social prescribing link workers, health and wellbeing coaches, and other professionals.

Primary Duties and Areas of Responsibility

Multi-Disciplinary Teams

• Overall responsibility for arranging any cancer specific required weekly PCN led MDT meetings and the smooth running of integrated care within the team setting. A key role of Early Cancer Care Coordinator will be to schedule the weekly MDT meetings, manage the meeting agenda items; ensuring that all new referrals are identified, and information circulated to team members in advance of the meeting.
• Take minutes of MDT meetings and disseminate; chase progress against actions identified in these meetings and ensure follow up where necessary.

Direct patient facing work

• Manage a caseload of patients identified through the MDT.
• Support patients to utilise decision aids in preparation for a shared decision-making conversation.
• Holistically bring together all of a persons identified care and support needs, and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person.
• Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written and verbal information to help them make choices about their care.
• Support people to take up training and employment, and to access appropriate benefits where eligible.
• Support people to understand their level of knowledge, skills and confidence (their Activation level) when engaging with their health and wellbeing, including through the use of the Patient Activation Measure.
• Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing and increase their activation level.
• Explore and assist people to access personal health budgets where appropriate.
• Communication and collaborative working relationships.
• Demonstrates ability to work as a member of a team.
• Is able to recognise personal limitations and refer to more appropriate colleague(s) when necessary.
• Actively work toward developing and maintaining effective working relationships both within and outside the PCN or group of PCNs.
• Liaises with other stakeholders as needed for the collective benefit of patients including but not limited to patients, GP, nurses, other practice staff and other healthcare professionals including pharmacists and pharmacy technicians from provider and commissioning organisations.
• Develop excellent working relationships with all the partners, wider service networks including the voluntary sector, GP practices, adult social care, hospitals, community pharmacists and other members of the MDT.
• Acting as a point of contact for residents, families, carers and professionals who visit the care home, such as MDT members, and in-reach specialists.
• Meet regularly with the clinical lead and review case load and MDT function.
• Keep the PCN aware of good news stories via TeamNet.
• Provide background information about individuals for the weekly MDT meetings.
• Communicate effectively with service users and their families/carers and provide coordination across health and care services working closely with social prescribing link workers, health and wellbeing coaches, and other primary care professionals.
• Manage and prioritise workload on a daily basis and deal with the competing demands of the MDT

Patient Care

• Communicate effectively and sensitively and use language appropriate to a patient and carer/relatives' condition and level of understanding
• Effectively use all methods of communication and be aware of and manage barriers to communication
• Effectively recognise and manage challenging behaviours, carers and or relatives
• Provide information to patients, their carers and/or relatives on behalf of the team
• The PCN will ensure the PCNs Care Coordinator can discuss patient related concerns and be supported to follow appropriate safeguarding procedures (e.g., abuse, domestic violence and support with mental health) with a relevant GP.

Supporting Care Delivery

• Be the point of liaison for service users and interface with all health and social care professionals, including keeping everyone informed and updated
• Follow through actions identified by the MDT including arranging tests, referrals, signposting, etc.
• Follow through with service users and others involved to ensure all services and care arrangements are in place
• Autonomy/Scope within Role

The post holder will be required to work within clearly defined organisational protocols, policies and procedures

Person Specification

Qualifications

Essential

• ECDL or equivalent
• Diploma / HNC level or relevant experience
• NVQ level 2 Business Administration or relevant experience
• Demonstrable commitment to professional and personal development

Desirable

• Training in motivational coaching and interviewing or equivalent

Experience

Essential

• Minimum of 2 years experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (including unpaid work)
• Experience in use of databases
• Experience of data collection and providing monitoring information to assess the impact of services
• Experience of partnership/collaborative working and of building relationships across a variety of organisations
• Experience of working with or in general practice
• Working in a multi-disciplinary setting where influence and negotiation is required
• Knowledge/familiarity with medical terminology

Desirable

• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Vulnerable adults awareness
• Experience of care of the elderly

Other

Essential

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Access to own transport and ability to travel across the locality on a regular basis
• Continued commitment to improve skills and ability in new areas of work

Skills and Knowledge

Essential

• Knowledge of the personalised care approach
• Creative problem solver and willing to search for hard-to-find information

Desirable

• Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports
• Knowledge of general practice clinical systems, such as, EMIS and SystmOne
• Ability to read large amounts of information and extract the salient points, to analyse data and report on findings

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Employer details

Employer name

Arun Integrated Care, Primary Care Network

Address

The Park Surgery

St. Floras Road

Littlehampton

West Sussex

BN17 6BF

Employer's website

https://www.innovationsinprimarycare.com/arun-integrated-care-pcn (Opens in a new tab)